Hospital Utilization Trends
Hospital utilization is recovering across key services following the COVID-19 pandemic. Ambulatory surgery (AS) services have increased slightly above pre-pandemic levels (1.2%), emergency department (ED) utilization remained at pre-pandemic levels, and inpatient (IP) stays are still modestly below pre-pandemic levels (4.3%).
Introduction
Hospitals across California experienced sharp declines in health care utilization at the start of the COVID-19 pandemic, affecting all care settings and most demographic groups. The largest declines occurred in chronic conditions such as diabetes, hypertension, and asthma. In contrast, utilization among people experiencing homelessness, as well as care for respiratory arrest or failure and stroke, did not show similar declines.
These visualizations present updated data and allow users to filter utilization trends by demographics, health conditions, hospital systems, and individual facilities.
HCAI’s visualizations are derived from patient administrative data from hospital billing systems and are not disease surveillance data. At the time of publishing, hospital data for 2024 is the most current and validated data available to HCAI. For the latest COVID-19 data from the state’s disease surveillance systems, please visit covid19.ca.gov.
Key Findings – 2020-2024
- Hospital utilization trends show a sharp initial decline at the onset of the COVID-19 outbreak. The decline was most pronounced for AS services (69.6%), followed by ED visits (54.1%) and IP services (30.9%) between January and April 2020.
- The recovery from the decline in service utilization occurred more rapidly for ED and AS services, while IP utilization recovered more slowly.
- The trend for patients who experience homelessness does not reflect the same change, aside from a decline in AS services in early 2020. Data reporting for people experiencing homelessness continues to improve over time.
- Hospital utilization throughout different demographics including age groups, assigned sex at birth, expected payer types, and racial and ethnic populations showed similar decreases in utilization across all care settings from January to April 2020, then gradually recovered to similar levels by October 2024.
- Hospital utilization followed similar patterns across major disease categories, including asthma, cancer, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, obesity, sepsis, mental and behavioral disorders, and stroke.
- Hospital utilization for conditions such as pneumonia, sepsis, cardiac arrest, and respiratory failure showed surges in hospital and emergency care during the pandemic, including a noticeable increase from November 2020 to January 2021. Unlike other conditions, their use did not drop in early 2020.
Hospital Utilization Overview
Three dimensions of utilization trends are analyzed:
- Utilization Trends by Setting: This visualization displays monthly patient encounter trends across IP, ED, and AS settings. All settings experienced declines in early 2020. IP discharges and AS services rebounded by March 2021, while ED volumes recovered more gradually. Filters allow users to refine views by care setting, facility, and year.
- Utilization Trends by Health Category: This visualization displays monthly utilization patterns for selected health conditions. Most conditions declined in early 2020; however, utilization among patients experiencing homelessness and for conditions such as cardiac arrest, respiratory failure, sepsis, and stroke was less affected. Filters allow users to select care settings, systems, facilities, conditions, and year.
- Utilization Trends by Demographics: This visualization displays monthly healthcare utilization data by demographic characteristics, including age group, race/ethnicity, sex assigned at birth, and expected payer. Users can compare trends across individual hospitals or multiple facilities. Filters allow selection by care setting, system, facility, demographic category, and year.
Visualization
How HCAI Created This Product
- “Homeless” encounters are identified by ICD-10-CM diagnosis code of Z59.0 in any diagnosis position, a patient ZIP code of ZZZZZ (indicating homelessness), or a Homelessness Indicator.
- HCAI identified encounters within IP discharges, ED treat and release utilization, and AS services from 2020-2024. HCAI’s visualizations are derived from patient administrative data from hospital billing systems and is not disease surveillance data. At the time of publishing, hospital data for 2024 is the most current and validated data available to HCAI. For the latest COVID-19 data from the state’s disease surveillance systems, please visit covid19.ca.gov.
- The COVID-19 trend lines begin with April 2020 when the COVID-19 specific diagnosis code U07.1 was added to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
- Trendlines for homeless patients may not reflect actuality due to variations in reporting over time.
- This product uses suppression of small numbers in all three visualizations. Any count below 11 was changed to 11 in the underlying dataset for de-identification purposes.
Glossary
Expected Payer: The payer type that was expected to pay the greatest share of the patient’s bill at the time of discharge, not the payer type that actually paid.
| Payer Grouping | Inpatient Discharges | Emergency Department Visits and Ambulatory Surgeries |
|---|---|---|
| Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Medicare Advantage and Medicare Fee-for-Service (Traditional Medicare). | Medicare | Medicare Part A, Medicare Part B, and Health Maintenance Organization (HMO) Medicare Risk |
| Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Managed Care and Medi-Cal Fee-for-Service. | Medi-Cal | Medicaid (Medi-Cal) |
| Private Health Insurance: Coverage by private, non-profit or commercial health plans or through organizations. Includes individual coverage purchased through Covered California, and organized charity payers (e.g., March of Dimes, Shriners). | Private Coverage | Preferred Provider Organization (PPO), Point of Service (POS), Exclusive Provider Organization (EPO), Blue Cross / Blue Shield, Commercial Insurance Company, and Health Maintenance Organization |
| Other Government: Public insurance programs other than Medicare or Medi-Cal, including federal, state, county and veteran-specific programs. | County Indigent, Other Government | CHAMPUS (TRICARE), Other Federal Program, Title V, Veterans Affairs Plan, and Other Non-Federal Programs |
| Self-Pay or Uninsured: Coverage where the greatest share of the patient’s bill is not expected to be paid by any other form of insurance or health plan. Includes uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private. | Other Indigent, Self-Pay | Self-Pay |
| All Other Payers: Includes payers not categorized elsewhere: Workers’ Compensation, Automobile Medical, disability insurance, third-party payment not included in any other category or stays for which no payment will be required by the facility (e.g. courtesy patients). | Workers’ Compensation, Other Payer | Automobile Medical, Disability, Workers’ Compensation Health Claim, Other |
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Patient-Level Administrative Data
Citation: HCAI – Patient-Level Administrative Data – Hospital Utilization Trends, 2020-2024
Temporal Coverage: 2020-2024
Spatial/Geographic Coverage: Statewide
Frequency: Annually